refractory cmd case
DESCRIPTION
Refractory CMD Case. 5 years of treatment, 3 years of “Hell”, 5 months of Torment; 4 days to basic comfort!!. Presentation 5/21. Glued On Splint, Hygiene??. Cemented Splint Fractured. Splint Ends First Molar. R. Lower Anterior with Splint Off. What is the Intent of Treatment?. - PowerPoint PPT PresentationTRANSCRIPT
Refractory CMD Case
5 years of treatment, 3 years of “Hell”,
5 months of Torment;
4 days to basic comfort!!
Presentation 5/21
Glued On Splint, Hygiene??
Cemented Splint Fractured
Splint Ends First Molar
R
Lower Anterior with Splint Off
What is the Intent of Treatment?
Extra Length,Molars in
Occlusion,
Would the resultantVector distalize the
Mandible?
Not Very Comfortable,
Old Mandibular Splint
Where is She
Rubbing?
Incisal Ramp
Is itbuilt out
a bit far?
1st Mark, Splint Rocks!
WhatIs the
Effect of A Rocking
Splint?
What do you call this splint?
What is the Basic Design?
Is this a TannerSplint?
NO!!!
Can we use it? If so, what is next step?
If so, what is next step?
RelineAndRe-
surface
PGA
1st Adjustment
2nd Adjustment
3rd Adjustment - “Freedom”
3 day PO, Splint Great, Chewing with Teeth Bad
1st Adjustment, Feels Good
4th Day PO, “Cadillac” of Splints
First Smile in Months
4th day PO, 1st Adjustment
Still Cannot Eat or Leave Splint Out
What is Next Check?
What is Next Check?
2+ Fremulous #8
Now What??
Allow her to feel motionAllow her to choose the affected
toothAsk permission to reshape a
toothWhich one?#25, lower right incisor!!!
Is it the Bevel on #25, or the length?
Unposed photo’s, 4 days apart
What is the real Effect??
Occlusal Impact
This early result could be achieved with an anterior jig or prop, Lucia or NTI.
The important aspect of the PGA is the muscle and joint stability.
We are also on a diagnostic path that is leading toward a stable conclusion.
Any anterior dis-occluding device must be replaced with a stable occlusal design.
PGA simulates a stable occlusal design and is in the progression to a final restoration.
